The change of leadership at the HSE ought to have prompted a radical, far-sighted overhaul of its accountability, if the Government was really putting the interests of citizens first.
The scale and complexity of the HSE is such that it functions like one of the major metropolitan cities of the world. The role of chief and deputy chief executive of the HSE is comparable to that of the mayor and deputy mayor of a major city, like London, Paris, Rome, Istanbul or Moscow.
The HSE’s enormous budget (€15 billion) is significantly greater than the combined budgets of the city councils of Boston, Chicago and Los Angeles. The salary of its incoming chief executive outstrips the combined salaries of the executive mayors of Chicago and Los Angeles, who oversee the needs of a population of over 6.6 million people.
The mayor who leads these huge cities faces the electorate every four years. The responsiveness of these mayors to the needs of the public is dynamic, focused and robust. Indifferent standards of hygiene, premature deaths as a consequence of an MRSA infection, botched operations, or prolonged delays in accident and emergency departments are unlikely to feature in the manifesto of a successful candidate seeking election nationally to run a health service system - anywhere in the world.
The board of the HSE could continue to be appointed by the Minister for Health and Children. But we, the people, need to feel we can strongly influence the system directly. Would the citizens of Boston, Chicago and Los Angeles feel short-changed if an anonymous apparatchik, chosen by unelected individuals, who are strangers to the public at large, were to emerge as leader of their city, spending their taxes? This issue is not one of promptly dealing with snow clearance from footpaths, policing or the consequences of devastating flooding, but it concerns matters that have a direct and immediate impact on living and dying.
Is it not reasonable, therefore, to want some say in who is in charge and to fire them if they fail? Such an initiative would redefine the relevance and value of social partnership in Ireland.